Nemergut Edward C, Dumont Aaron S, Barry Usha T, Laws Edward R
Departments of *Anesthesiology and †Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.
Anesth Analg. 2005 Oct;101(4):1170-1181. doi: 10.1213/01.ane.0000166976.61650.ae.
Pituitary adenomas often present with the symptoms of hormonal hypersecretion, and although medical therapy is available for most hyperfunctioning states, it is not curative. As a result, transsphenoidal pituitary surgery has become a commonly performed neurosurgical procedure with unique challenges for the anesthesiologist due to the distinct medical comorbidities associated with various adenomas. Any type of pituitary tumor may also produce hypopituitarism and local mass effects secondary to the expanding intrasellar mass. Here we review the perioperative concerns surrounding surgery to remove adenomas and decompress the sellar space. Special attention is given to Cushing's disease (hypercortisolism secondary to an adrenocorticotropic hormone-secreting adenoma), acromegaly (secondary to a growth hormone-secreting adenoma), and hyperthyroidism in the setting of thyrotropic adenomas. Operative risks, including bleeding, diabetes insipidus, the syndrome of inappropriate antidiuretic hormone secretion, and hypopituitarism, are addressed in detail. Understanding preoperative assessment, intraoperative management, potential complications, their management, and strategies for avoidance are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.
垂体腺瘤常表现为激素分泌过多的症状，尽管大多数功能亢进状态都有药物治疗方法，但无法治愈。因此，经蝶窦垂体手术已成为一种常见的神经外科手术，由于各种腺瘤相关的独特医学合并症，给麻醉医生带来了独特的挑战。任何类型的垂体肿瘤也可能导致垂体功能减退以及鞍内肿块扩大引起的局部占位效应。在此，我们回顾围绕腺瘤切除和鞍区减压手术的围手术期关注点。特别关注库欣病（促肾上腺皮质激素分泌腺瘤继发的皮质醇增多症）、肢端肥大症（生长激素分泌腺瘤继发）以及促甲状腺激素腺瘤导致的甲状腺功能亢进。详细讨论了手术风险，包括出血、尿崩症、抗利尿激素分泌不当综合征和垂体功能减退。了解术前评估、术中管理、潜在并发症、其处理方法以及避免策略对于围手术期患者的成功护理以及避免发病和死亡至关重要。
